Perception of rheumatology

[tofunami]

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After reading the results of webMDs physician lifestyle report it made me wonder why it is one of the least popular specialties available for IM.

After doing a month rotation and working in several rheum clinics during my ambulatory months Im trying to build a case for specializing in rheum. I'm just apprehensive because of its lack of popularity and the off chance that I may be missing something COMPLETELY which would turn me off to it.

What are some of the preconceptions out there that make so many people avoid this subspecialty?

Some of the things I've thought of:
1) Patients constantly complaining of pain
2) Largely lab result driven (i.e. cerebral specialty that depends on labs results for diagnosis)
3) The nebulous nature of patient's complaints (fatigue, total body dalor)
4) Few connective diseases fit perfectly into one defined entity making diagnosis difficult for some patients

For the most part, I don't mind these things. What the heck am I missing here?

 

[hardyharhar]

My take on this is that most people add up all those things you mentioned and then say that "250K/year" is not "enough" compensation, probably in comparison to GI or Cards salaries. I do think there is a healthy amount of fear of "the nebulous pain-seeking" patient, but people forget that rheumatology is still a medical science and rheumatologists have every freedom to "deal" with ass-patients as any other specialist (nebulous abdominal pain, chest pain, and cyclical vomiters) does. Here's a good psychiatrist, and there's the door!

 

[pntgrd]

90% of rheum practice is outpatient, but residents get most of their training inpatient, so they aren't exposed to much of how real rhuem is practiced.

 

[bronx43]

My take on this is that most people add up all those things you mentioned and then say that "250K/year" is not "enough" compensation, probably in comparison to GI or Cards salaries. I do think there is a healthy amount of fear of "the nebulous pain-seeking" patient, but people forget that rheumatology is still a medical science and rheumatologists have every freedom to "deal" with ass-patients as any other specialist (nebulous abdominal pain, chest pain, and cyclical vomiters) does. Here's a good psychiatrist, and there's the door!

That's basically all you need to know. GI is competitive, because of high reimbursement for scopes. When (not even a question of if) it goes through the same cutting floor as everything else in medicine, GI will plummet in popularity. There is nothing intrinsically sexy or interesting about GI to explain the competitive nature. Cardiology is competitive for similar financial reasons, except I would go out on a limb and say that more people find cardio physiology interesting.
If rheumatology had a cash cow procedure like allergy, it would be one of the more competitive subspecialties in medicine.

 

[Rheumination]

Rheum is awesome! Don't avoid it just because others aren't chasing after it. It's nice to go into a subspecialty that's a little bit less competitive. Some of the wonderful things:

--Lots of interesting research opportunities
--very interdisciplinary
--still think about the whole pt (don't have to choose an organ)
--few emergencies (the ones that are true emergencies are very interesting)
--long term relationships with patients.

As far as your other concerns, I think that rheumatologists generally treat pain by getting to the source of the problem. Few hand out narcotics, from what I've seen, at least. Fibromyalgia is dealt with very differently (some places have fibro clinics, others refuse to see them at all). I do think it can be somewhat unsatisfying when pts have something funky, with a stack of outside medical records, and there is not a diagnosis. That's something you'd have to live with.

Good luck, hope you enjoy rheum

 

[RAtrucker]

If I could have a do over in life I would choose rheumatology. Granted, I have a vested interest in this specialty because I have RA.

If you want to know why you should choose rheumatology it is simple- you will absolutely be able to make profound and lasting differences in patient's lives- and you'll be looking them in the face when you do it, not at an organ. Since most of the more common rheumatic diseases are chronic, you'll have the same patient's for most of their lives. As many autoimmune diseases are on the rise the shortage of rheumatologists increases.

Ask your average blue collar what a cardiologist is and they'll probably at least have a clue; but ask them what a rheumatologist is and you're talking Greek to them. Rheumatology is still a bit of a mystery to many and I think this is why it is less competitive than other fields.

Good luck to you all. 🙂

 

[Silent Cool]

That's basically all you need to know. GI is competitive, because of high reimbursement for scopes. When (not even a question of if) it goes through the same cutting floor as everything else in medicine, GI will plummet in popularity. There is nothing intrinsically sexy or interesting about GI to explain the competitive nature. Cardiology is competitive for similar financial reasons, except I would go out on a limb and say that more people find cardio physiology interesting.
If rheumatology had a cash cow procedure like allergy, it would be one of the more competitive subspecialties in medicine.

Yup, I completely agree. "There's gold in ****" is the only reason GI is popular. Once reimbursement for scopes is cut, it will lose popularity, much as Cards has also lost popularity recently. I agree, though, that Cards does have aspects that are inherently interesting--much more so than scoping rear end all day.

 

[TheSeanieB]

Out of curiousity, how many years is a rheumatology fellowship?

 

[Cinclus]

Out of curiousity, how many years is a rheumatology fellowship?

Two years.

 

[gutonc]

Out of curiousity, how many years is a rheumatology fellowship?

Out of curiosity, have you heard of Google?

 

[TheSeanieB]

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